Pre-operative use of Lugol’s iodine in a case with toxic adenomatous goiter

Abstract

Euthyroid state is considered a requisite before planning a thyroid surgery. Before such a surgery, pharmacotherapy can be used for managing a hyperthyroid state. It warrants a long-term treatment with pharmacotherapy agents like imidazole class (carbimazole, methimazole) or propylthiouracil. In cases with large goiters, with pressure symptoms like dyspnoea, dysphagia, dysphonia; a surgeon would prefer a pharmacotherapy with a quicker action than the established agents. Lugol’s iodine was used pre-operatively before the advent of newer agents. In rural areas, where patients present with large goiters, hyperthyroid states due to lack of awareness and availability of the modern pharmacotherapy, Lugol’s iodine can be a rescue pre-operative therapy to make such a patient euthyroid and to decrease the vascularity of the goiter, which facilitates a safer thyroid surgery.

Risk Factors and Clinical Manifestations in Hyperthyroidism: Case Report

“…Ten kinds of literature were found involving adult patients aged >25 years with quite diverse thyroid disorders such as toxic adenoma, psychosis, autoimmune thyroid, and thyroid papillary cancer. Clinical manifestations, as in Table 1, generally show clinical symptoms such as swelling of the thyroid gland, difficulty breathing, progressive weight gain, tremors, and palpitations 9,13,14 . Researchers also found manifestations that appear in visual disturbances, namely pain in the eye area, conjunctival hyperemia, swollen eyelids, reduced visual acuity (6/18), and reduced color vision; this condition is related to thyroid eye disease 16 .…”

“…Previous studies have also shown that all three treatment methods (anti-thyroid medications, radioactive iodine, and surgery) show good results on the long-term quality of life of patients 28 . In some cases, anti-thyroid medication is most commonly given in patients with toxic adenoma, psychosis, fetal hyperthyroidism, fetal goiter, autoimmune, thyroid eye disease, and anxiety disorders 2,9,10,13,16,18 . Anti-thyroid medications that are widely used in the findings of the cases discussed are methimazole with varying doses of 0.5mg to 30mg/kg/day.…”